Why You Should Treat Enlarged Prostate With Drugs Before Surgery

Q: How long should a man with benign prostatic hyperplasia be treated with medications before having surgery, if he still gets up a couple times at night?

A: In general, men who take drugs for benign prostatic hyperplasia do so to avoid surgery and to improve the bothersome symptoms, including:

--Frequent trips to the bathroom to urinate

--A sense of having to urinate immediately

--A slow stream

--A feeling that the bladder is not completely emptying

--Getting up at night to urinate

There are two types of drugs for treating these symptoms. I generally recommend that a man try both before considering surgery. One type relaxes the muscles at the bottom of the bladder. This allows easier urine flow. These are called alpha blockers, such as:

--Alfuzosin (Uroxatral)

--Doxazosin (Cardura)

--Tamsulosin (Flomax)

--Terazosin (Hytrin)

The other type of drug shrinks the enlarged prostate gland, making it easier to urinate. Two are FDA approved: dutasteride (Avodart) and finasteride (Proscar). In general, it can take up to a year for these to shrink the prostate gland.

Whether to have surgery is a personal choice, and depends upon the degree to which the man is bothered by the symptoms.

I often advise men to fill out a questionnaire (the AUA of IPSS symptom score questionnaire) that asks about the degree of symptoms and quality of life associated. After several months of drug treatment, the questionnaire can be filled out again and compared to the original. This can help provide a more objective assessment of how well treatment is working.

In general, I encourage men to try medication for 12 to 18 months. If the symptoms have not improved, it may worthwhile to consider surgery.

However, a word of caution about having surgery primarily because you get up at night: For reasons we do not fully understand, men who have surgery can still need to get up in the night to urinate.

The decision to undergo surgery also depends upon the type of side effects men are having with the medicines. It may not be the symptoms, per se, that are bothersome, but rather the side effects of the different types of medicines.

It is also important for the man contemplating surgery to speak to other men who have undergone it to get an understanding about the side effects of the surgery.

(Dr. Garnick is an internationally renowned expert in medical oncology, with a special emphasis on prostate cancer. He is a Clinical Professor of Medicine at Harvard Medical School and maintains an active oncology practice at Beth Israel Deaconess Medical Center, Boston, Mass. Dr. Garnick serves as Editor in Chief of Perspectives on Prostate Diseases, a quarterly report from Harvard Health Publications.)